ABSTRACT
INTRODUCTION: Ambulatory treatment of acute uncomplicated diverticulitis has been shown to be safe and effective by several recent studies. The aim of our study was to analyze the outcome of general practice management concerning the complications, the treatment modalities and the hospitalization duration during the first episode of acute diverticulitis. MATERIEL AND METHODS: A total of 176 medical files of patient presenting between January 2000 and December 2010 at the emergency department with a first episode of acute diverticulitis confirmed by an abdominal CT scan were analyzed. Among the 160 patients fulfilling the inclusion criteria, 50 were referred by a general practitioner (GP). Data concerning admission modalities, clinical status, paraclinic investigations, complications, treatment and length of hospital stay were reviewed. RESULTS: The patients referred by the GP were significantly older (p ⟨ 0.001) and were hospitalized significantly longer (p = 0.034) than the patients consulting directly the emergency department. There was a significant correlation between the 2 variables (R = 0.406). Complications and treatment modalities did not differ between the two groups. Complicated diverticulitis was associated with rebound (p = 0.049), tenderness (p = 0.005) and a time interval between initial symptoms onset and admission to the emergency department superior to 4 days (p = 0.027). CONCLUSIONS: Ambulatory management of acute diverticulitis by the GP does not affect the outcome of the patients after their hospital admission in term of complications and treatment modalities. Ambulatory treatment of acute diverticulitis is safe but hospitalization is indicated in case of poor clinical tolerance, presence of rebound, tenderness and duration of symptoms for more than 4 days.
INTRODUCTION: Le traitement ambulatoire des diverticulites non compliquées est efficace et recommandé dans plusieurs études. Le but de notre étude était d'analyser l'impact de la prise en charge en médecine générale sur les complications, les modalités de traitement et la durée d'hospitalisation lors d'un premier épisode de diverticulite. MATERIEL: 176 dossiers ont été analysés. Parmi les 160 patients retenus, 50 étaient adressés par un médecin traitant. Les critères d'inclusion étaient : admission via les urgences avec un premier épisode de diverticulite confirmé par au moins un CT scanner. Les données analysées étaient l'anamnèse, les paramètres cliniques et paracliniques, les complications, les traitements et la durée d'hospitalisation. RESULTATS: Les patients adressés par le médecin traitant ont une durée d'hospitalisation plus longue (p = 0,034) et sont plus âgés (p ⟨ 0,001) que ceux se présentant directement aux urgences avec une corrélation significative entre les 2 variables (R = 0,406). Aucune différence significative n'a été retrouvée en termes de complications et de modalités de traitement entre les deux groupes. Le rebond (p = 0,049), la défense (p = 0,005), et un délai entre le début des plaintes et l'admission aux urgences supérieures à 4 jours (p = 0,027) étaient les facteurs associés à une diverticulite compliquée. CONCLUSION: La prise en charge en médecine générale des diverticulites aiguës ne modifie pas le devenir des patients lors de leur admission à l'hôpital en termes de complications et de modalités de traitement. Le traitement ambulatoire des diverticulites simples est recommandé, mais en cas de mauvaise tolérance clinique, telle que la présence d'un rebond, d'une défense et des symptômes de plus de 4 jours, une hospitalisation est indiquée et justifiée.
ABSTRACT
Furuncular myiasis is a wel l established cutaneous parasitosis in tropical area. In Europe, most of cases have been described in patients returning from risk areas. We report a case of a 4-year old child with a furuncular lesion on his left thigh considered as an abscess and who was send to emergency department for surgical drainage.
La myiase furonculeuse est une parasitose cutanée bien connue dans les régions tropicales. En Europe, des cas rares ont été décrits chez des patients ayant séjourné dans les zones à risque. Nous rapportons le cas d'un enfant de 4 ans présentant un furoncle au niveau de la cuisse gauche considéré à tort comme un abcès et envoyé aux urgences pour drainage.
Subject(s)
Abscess/pathology , Myiasis/pathology , Abscess/parasitology , Child, Preschool , Diagnosis, Differential , Emergencies , Humans , Male , Thigh/parasitology , Thigh/pathologyABSTRACT
BACKGROUND: Cardiac wounds remain as highly lethal lesions in which their prognosis depends on the emergency management. OBJECTIVES: The aim of this study is to analyse experiences of cardiac surgeons in different hospitals in Brussels and compare it with the findings in the literature. METHODS: From 1st January 1990 till 1st December 2010, all penetrating cardiac wounds in three Brussels hospitals were retrospectively reviewed. Data recorded included clinical parameters, surgical constatation and outcome. RESULTS: A total of fourteen (12 male/2 female) patients sustained penetrating cardiac injuries. There were thirteen patients (93%) with stabs wounds and, one patient (7%) with gunshot wound. Wound locations are as follows: ten patients (71%) right ventricle, three patients (22%) the pericardium, and one patient (7%) the left ventricle. The hemodynamic status was unstable in nine patients (64%), in-extremis in two patients (14%) and stable in three patients (22%). The mean Abbreviate Injury Score was 4.6 and the mean New Injury Severity Score was 31. Thirteen patients (93%) had operations (11 sternotomie, 2 thoracotomies). Two patients required cardiopulmonary bypass. Three patients (22%) died. CONCLUSION: Penetrating cardiac wounds are relatively rare in Belgium, which is mainly due to stabs and with consequent mortality. The implementation of clear guidelines is necessary to improve survival.
Subject(s)
Cardiac Surgical Procedures/statistics & numerical data , Heart Injuries/epidemiology , Hospitals, University/statistics & numerical data , Urban Population , Wounds, Stab/epidemiology , Adolescent , Adult , Aged , Belgium/epidemiology , Female , Heart Injuries/diagnosis , Heart Injuries/surgery , Heart Ventricles/injuries , Humans , Incidence , Injury Severity Score , Male , Middle Aged , Pericardium/injuries , Prognosis , Retrospective Studies , Wounds, Stab/diagnosis , Wounds, Stab/surgery , Young AdultABSTRACT
PURPOSE: This study analysed the clinical and para-clinical criteria that may allow surgeons and emergency physicians to take a decision regarding the surgery of acute appendicitis. METHODS: A retrospective analysis was conducted on 284 acute appendicitis patients who underwent surgery between January 2007 and December 2009 in our institution. The registered data were extracted from patient files and statistically analysed. These data included past medical history, clinical, laboratory and imaging data, duration of hospital stay and post-operative complications. Patient delay (time between the appearance of symptoms and patient arrival at the emergency department) and hospital delay (time between hospital arrival and operation) were correctly investigated. Statistical analysis was done by using SPSS software. RESULTS: The patient delay is significantly increased in relation to the severity of appendicitis: 24 h (10.8-30.8 h) versus 37.4 h (36.8-38 h) (P < 0.05), unlike hospital delay, which remains constant (between simple and severe appendicitis): 7.5 h (5-14.8 h) versus 8 h (5-13 h). In severe appendicitis, the proportion of guarding, rebound tenderness, tachycardia (P < 0.05) and fever (P < 0.005) were significantly high, and leucocytosis (P < 0.05), C-reactive protein (CRP) (P < 0.001) and eosinopaenia [37.0 vs. 72.8 (P < 0.001)] were significantly different. Concerning computed tomography (CT) and echography, perforation, abscess formation (P < 0.05), phlegmon (P < 0.005) and peritonitis (P < 0.05) were significant signs of complicated cases. The length of hospital stay (P < 0.001) and duration of antibiotic therapy (P < 0.001) were statistically significant in cases of complicated appendicitis. CONCLUSION: Patient delay is a determining factor for the grade of appendicitis. It has an influence on the complications, length of hospital stay and duration of antibiotic treatment, unlike hospital delay.
ABSTRACT
BACKGROUND: The RNA genome of hepatitis C virus (HCV) displays extensive sequence variation. In this study, serotyping and genotyping techniques were applied to assess this variability by comparing the performance of the serotyping assay with a panel of well-characterized HCV strains isolated from chronic active hepatitis (CAH) patients. PATIENTS AND METHODS: 60 serum samples from CAH patients were analyzed. All isolates were genotyped by a line probe assay and the results of genotyping and serotyping were evaluated. RESULTS: The overall sensitivity of the serotyping and genotyping techniques was 81.16% with a concordance of 73.3%. Type 4 was detected in 73.3% of cases and it was highly heterogeneous. CONCLUSION: Type 4 HCV is the most prevalent type in Egyptian CAH patients and there is a high concordance between the results of serotyping and genotyping techniques.
Subject(s)
Hepacivirus/classification , Hepatitis C/virology , Serotyping/methods , Egypt , Genotype , Hepacivirus/genetics , Hepacivirus/isolation & purification , Hepatitis C/immunology , Humans , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and Specificity , Viremia/immunology , Viremia/virologyABSTRACT
One hundred cases aged 4-20 years and suffering from chronic tonsillitis were examined for Toxoplasma antibodies using indirect immunofluorescent test (IFAT). It was found that 37% of them were positive for toxoplasmosis. 41.5% of hypertrophic cases and 32% of atrophic ones had toxoplasmosis but the difference was statistically insignificant. The mean antibody titres were higher in both atrophic and hypertrophic cases than in the control group. The patients aged from 11-20 years had a higher titre of Toxoplasma antibodies than those aged below ten years. Trials to detect tachyzoites, cysts or pseudocysts in fixed paraffin sections using Hx & E, PAS or Giemsa stains were not successful. The histopathological picture of tonsils removed from positive cases of toxoplasmosis showed characteristics of toxoplasmic lymphadenitis.
Subject(s)
Tonsillitis/complications , Toxoplasmosis/complications , Adolescent , Adult , Animals , Antibodies, Protozoan/analysis , Child , Child, Preschool , Chronic Disease , Fluorescent Antibody Technique , Humans , Toxoplasma/immunologyABSTRACT
Of 26 patients infested with Strongyloides stercoralis 10 (38.5%) were asymptomatic without systemic or cutaneous signs. Nine patients (34.6%) presented with systemic complaints only and seven patients (26.9%) had systemic and cutaneous manifestations. Further observations of the skin lesions on four of those with systemic and cutaneous manifestations revealed linear urticarial bands, extending to several centimeters within 1 hour and persisting up to many days, waiting and waning. Blood examination showed eosinophilia in all patients. These findings confirm the concept that larva currens even alone should be considered a cutaneous sign of systemic disease.